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 Table of Contents  
CASE REPORT
Year : 2021  |  Volume : 9  |  Issue : 2  |  Page : 290-292

Primary Malignant Melanoma of the Stomach: A Rare Entity


1 Department of Pathology, IGMC, Shimla, Himachal Pradesh, India
2 Department of Gastroenterology, IGMC, Shimla, Himachal Pradesh, India

Date of Submission23-Apr-2021
Date of Decision17-Oct-2021
Date of Acceptance19-Oct-2021
Date of Web Publication29-Dec-2021

Correspondence Address:
Dr. Sarita Asotra
Flat No-5, Block No-5, Phase-3, New Shimla - 171 009, Himachal Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/amhs.amhs_88_21

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  Abstract 


Primary gastrointestinal malignant melanoma is an unusual clinical entity. With primary gastric melanoma being very rare, Primary gastric melanoma is underdiagnosed as clinical manifestations are not specific and usually similar with other common malignancies at this site such as gastric cancer and lymphoma. Most melanomas found in the stomach are metastases from cutaneous source. Cutaneous source with nonspecific signs and symptoms. We report a case of a 65-year-old women with pain abdomen and vomiting. We submit this report as primary gastric melanoma is a rare entity with aggressive behavior and poor prognosis

Keywords: Gastrointestinal cancer, malignant melanoma, stomach


How to cite this article:
Asotra S, Mehta A, Sharma B. Primary Malignant Melanoma of the Stomach: A Rare Entity. Arch Med Health Sci 2021;9:290-2

How to cite this URL:
Asotra S, Mehta A, Sharma B. Primary Malignant Melanoma of the Stomach: A Rare Entity. Arch Med Health Sci [serial online] 2021 [cited 2022 Jan 29];9:290-2. Available from: https://www.amhsjournal.org/text.asp?2021/9/2/290/334027




  Introduction Top


Malignant melanoma is a malignant proliferation of melanocytes. It usually occurs in sites where melanocytes are normally found such as skin, inner ear, uveal tract, anal canal, and oral cavity.[1] Gastric melanoma is a rare entity with most being metastatic and primary gastric melanoma being extremely rare. The median survival time for melanoma patients presenting with gastrointestinal (GI) invasion is less than a year.[2] To distinguish between primary or metastatic gastric melanoma history, laboratory investigations and imaging studies are necessary. Here, we present a case of gastric melanoma in a 65-year-old women diagnosed on gastric biopsy.


  Case Report Top


A 65-year-old women presented with pain abdomen and chest radiating to back along with vomiting and breathlessness. Ultrasonography of abdomen was unremarkable. On contrast-enhanced computer tomography (CECT) of the abdomen, partly proliferative and ulcerative, focally necrotic mural thickening of the entire stomach was noted with multiple upper abdominal lymphadenopathies [Figure 1].
Figure 1: Computed tomography showing stomach wall thickening and polypoidal growth

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On upper GI endoscopy, black friable ulcerated mucosa seen in the proximal stomach and distal part was normal [Figure 2] Gastric biopsy was taken and sent for histopathology.
Figure 2: On upper gastrointestinal endoscopy, black friable ulcerated mucosa seen in the proximal stomach

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Grossly, multiple gray brown to blackish soft-tissue pieces all together measuring 5 cubic mm were received. Microscopic examination of the gastric biopsy revealed focal ulceration of the surface epithelium. Lamina propria showed infiltration of medium to large tumor cells with moderate pleomorphism, vesicular chromatin, prominent eosinophilic nucleoli, and moderate-to-abundant cytoplasm with brown-black pigment. Occasional nuclear inclusions and increased mitotic activity were noted. In addition, normal gastric glands were also seen [Figure 3]. Immunohistochemistry for HMB-45 and S-100 showed diffuse and strong positivity [Figure 4].
Figure 3: Infiltration of medium to large tumor cells with moderate pleomorphism, vesicular chromatin, prominent eosinophilic nucleoli, and moderate to abundant cytoplasm with brown-black pigment 4 H and E, ×400

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Figure 4: Immunohistochemistry for HMB-45 showed diffuse and strong positivity

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A histopathological diagnosis of malignant melanoma on gastric biopsy was given.

The patient denied any history of cancerous lesions of the skin. A complete examination of his skin including oral and anal mucosa showed no suspicious lesions. Furthermore, fundoscopic examination of the eye was normal. A diagnosis of advanced primary gastric melanoma was made. The patient was advised positron emission tomography (PET) scan, which showed no accumulation of tracer except for tumor in the stomach indicating that it was a primary malignant melanoma of the stomach. The patient was subsequently lost to follow-up.


  Discussion Top


Malignant melanoma most commonly develops in the skin. On the basis of location, it is usually divided into cutaneous melanoma arising from melanocytes in the epidermis, mucosal melanoma from melanocytes residing in the mucous membranes, and uveal melanoma from melanocytes residing in the ocular stroma.[3] Cutaneous melanoma is the most common among all forms with incidence of 6.2%.[4] In rare instances, primary mucosal melanoma can arise from mucosa of the stomach is least common among all. Gastric melanoma is a rare form of mucosal melanoma with most cases being metastatic and primary melanoma being very rare.

Criteria for the diagnosis of primary gastric melanoma includes.[5],[6]

  1. A single melanoma lesion in the stomach proven by histopathology
  2. Absence of melanoma lesion elsewhere in the body
  3. Negative personal history for melanoma
  4. Disease-free survival of at least 12 months after curative surgery.


Presentation of gastric melanoma is similar to other gastric malignancies presenting with pain abdomen, vomiting, hematemesis, melena, anemia, nausea, and weight loss.[7]

Imaging studies including CECT, magnetic resonance imaging, and fluorodeoxyglucose-PET scan are important to know the location of the primary tumor and to rule out any concurrent tumor elsewhere in the body aiding the diagnosis of primary gastric melanoma.[8] Histopathological diagnosis, however, remains the gold standard for diagnosis of melanoma as seen in cutaneous/uveal/other mucosal melanomas.

The average survival of patient with GI melanoma is 1–1.5 year and those with primary gastric melanoma is 5 months.[9] This is attributed to predilection of GI melanoma for dissemination in early time due to abundant vascular and lymphatic supply of the GI tract.[10]

Main stay of treatment is surgery along with chemotherapy, increasing the average survival up to 12 months and radiotherapy may be used as a palliative treatment.[11]


  Conclusion Top


Primary gastric melanoma is a very rare diagnostic entity. It has very aggressive behavior and poor prognosis. However, early detection/diagnosis and treatment can increase the survival, but still the prognosis remains poor.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Tas F, Keskin S, Karadeniz A, Dağoğlu N, Sen F, Kilic L, et al. Noncutaneous melanoma have distinct features from each other and cutaneous melanoma. Oncology 2011;81:353-8.  Back to cited text no. 1
    
2.
Basagoiti ML, Vesga F, Losada J, Villanueva-Edo A. Gastric metastasis of melanoma. Rev Esp Enferm Dig 1992;82:419-21.  Back to cited text no. 2
    
3.
Ali Z, Yousaf N, Larkin J. Melanoma epidemiology, biology and prognosis. EJC Suppl 2013;11:81-91.  Back to cited text no. 3
    
4.
Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2021;71:209-49.  Back to cited text no. 4
    
5.
Elsayed AM, Albahra M, Nzeako UC, Sobin LH. Malignant melanomas in the small intestine: A study of 103 patients. Am J Gastroenterol 1996;91:1001-6.  Back to cited text no. 5
    
6.
Callaghan GM, Kelleher FC, Ridgway PF, Crowther S, Alakkari A, Ryan BM. A case of primary gastric melanoma exhibiting a rare BRAF V600R mutation. Eur J Case Rep Intern Med 2018;5:000749.  Back to cited text no. 6
    
7.
Ferreira RI, Dentz LC, AssisEmílio Augusto CP, Laboissière RS. Primary gastric melanoma: A case report of a rare malignancy. J Bras Patol Med Lab 2020;56:E2152020.  Back to cited text no. 7
    
8.
Wang J, Yang F, Ao WQ, Liu C, Zhang WM, Xu FY. Primary gastric melanoma: A case report with imaging findings and 5-year follow-up. World J Gastroenterol 2019;25:6571-8.  Back to cited text no. 8
    
9.
Wiewiora M, Steplewska K, Piecuch JZ, Piecuch J. A rare case of primary gastric melanoma. Indian J Surg 2020;82:442-4.  Back to cited text no. 9
    
10.
Jelincic Z, Jakic-Razumovic J, Petrovic I, Cavcic AM, Unusic J, Trotic R. Primary malignant melanoma of the stomach. Tumori 2005;91:201-3.  Back to cited text no. 10
    
11.
Cheung MC, Perez EA, Molina MA, Jin X, Gutierrez JC, Franceschi D, et al. Defining the role of surgery for primary gastrointestinal tract melanoma. J Gastrointest Surg 2008;12:731-8.  Back to cited text no. 11
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]



 

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